Provider Demographics
NPI: | 1134293244 |
---|---|
Name: | JOHNSON LABORATORY INC |
Entity Type: | Organization |
Organization Name: | JOHNSON LABORATORY INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER MANAGING SUPERVISOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | KATINA |
Authorized Official - Middle Name: | EILEEN |
Authorized Official - Last Name: | BEITZEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 740-622-3971 |
Mailing Address - Street 1: | 660 MAIN STREET |
Mailing Address - Street 2: | |
Mailing Address - City: | COSHOCTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43812 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 740-622-3971 |
Mailing Address - Fax: | 740-622-5150 |
Practice Address - Street 1: | 660 MAIN STREET |
Practice Address - Street 2: | |
Practice Address - City: | COSHOCTON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43812 |
Practice Address - Country: | US |
Practice Address - Phone: | 740-622-3971 |
Practice Address - Fax: | 740-622-5150 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-20 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 4425812 | Medicaid | |
OH | 4425812 | Medicaid |